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Migraine, Migraine Features, and Cardiovascular Disease

Authors

  • Markus Schürks MD, MSc,

    1. From the Division of Preventive Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (M. Schürks, J.E. Buring, and T. Kurth); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (J.E. Buring and T. Kurth); Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA (J.E. Buring); INSERM Unit 708, Neuroepidemiology, Paris, France (T. Kurth); UPMC University Paris 06, UMR_S708, Paris, France (T. Kurth); Department of Neurology, University Hospital Essen, Germany (M. Schürks).
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  • Julie E. Buring ScD,

    1. From the Division of Preventive Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (M. Schürks, J.E. Buring, and T. Kurth); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (J.E. Buring and T. Kurth); Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA (J.E. Buring); INSERM Unit 708, Neuroepidemiology, Paris, France (T. Kurth); UPMC University Paris 06, UMR_S708, Paris, France (T. Kurth); Department of Neurology, University Hospital Essen, Germany (M. Schürks).
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  • Tobias Kurth MD, ScD

    1. From the Division of Preventive Medicine, Department of Medicine; Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (M. Schürks, J.E. Buring, and T. Kurth); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (J.E. Buring and T. Kurth); Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA (J.E. Buring); INSERM Unit 708, Neuroepidemiology, Paris, France (T. Kurth); UPMC University Paris 06, UMR_S708, Paris, France (T. Kurth); Department of Neurology, University Hospital Essen, Germany (M. Schürks).
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  • Full disclosures: Dr. Schürks has received within the last 5 years investigator-initiated research funds from the Deutsche Forschungsgemeinschaft and the Migraine Research Foundation and honoraria from L.E.K. Consulting for telephone surveys. Dr. Buring has received within the last 5 years investigator-initiated research funding and support as Principal Investigator from the National Institutes of Health and Dow Corning Corporation; research support for pills and/or packaging from Bayer Health Care and the Natural Source Vitamin E Association; honoraria from Bayer for speaking engagements. Dr. Kurth has received within the last 5 years investigator-initiated research funding from Bayer AG, the National Institutes of Health, McNeil Consumer & Specialty Pharmaceuticals, Merck, Wyeth Consumer Healthcare, and the Migraine Research Foundation; he is a consultant to i3 Drug Safety and World Health Information Science Consultants, LLC, and he has received honoraria from Genzyme, Merck, and Pfizer for educational lectures.

  • Funding and support: The Women's Health Study is supported by grants from the National Heart, Lung, and Blood Institute (HL-43851, HL-80467), and the National Cancer Institute (CA-47988). The research for this work was supported by grants from the Donald W. Reynolds Foundation.

  • Conflict of Interest: None

M. Schürks, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, 3rd Floor, Boston, MA 02215-1204, USA.

Abstract

(Headache 2010;50:1031-1040)

Background.— Many studies support an association between migraine and cardiovascular disease (CVD). This association appears particularly in migraine with aura and is also modified by additional factors.

Objective.— We sought to investigate whether the association between migraine and CVD in addition to aura status is affected by certain migraine features.

Methods.— Cohort study among 27,840 women, participating in the Women's Health Study. We had detailed self-reported information on migraine and migraine features among women with active migraine (migraine during the year prior to baseline). Incident CVD events were confirmed after medical record review. We used Cox proportional hazards models to evaluate the association between migraine and incident CVD. The results have been presented in part before. We ran additional analyses according to migraine features.

Results.— At baseline, 5125 (18.4%) women reported history of migraine; 39.7% of the 3610 women with active migraine indicated aura. During a mean of 11.9 years of follow-up, 708 CVD events occurred. Migraine with aura doubled the risk for CVD, ischemic stroke, and myocardial infarction. With regard to ischemic stroke, this association seemed stronger in the absence than in the presence of migraine features. This was most pronounced in the absence (hazard ratio = 3.27; 95% CI = 1.93-5.51; P < .0001) than in the presence of nausea/vomiting (hazard ratio = 0.91; 95% CI = 0.43-1.93; P = .80). In contrast, the association with myocardial infarction did not reveal a certain pattern.

Conclusions.— These data suggest that the association between migraine with aura and ischemic stroke may differ by absence or presence of migraine features.

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